Individualized Fear and Avoidance Hierarchy

The Individualized Fear and Avoidance Hierarchy (Norton & Hope, 2005) was created for use in a study on a broad-spectrum cognitive-behavioral group therapy for anxiety. The hierarchy is an individualized list of 10 anxiety-eliciting situations or stimuli that are collaboratively rank ordered by the client and therapist by degree of difficulty the client would experience upon exposure to the stimulus or situation. Items on the hierarchy are then rated on a 0 (No anxiety or avoidance) to 100 (Extreme anxiety or avoidance) scale reflecting the degree of anxiety the client believes each situation or stimulus would produce. The Individualized Fear and Avoidance Hierarchy was developed to include fears from the entire range of a client's complaints. Therefore, for clients with multiple comorbid anxiety diagnoses, the hierarchy assessed components of each diagnosis. To ensure the clinical significance of each item on the hierarchy, a minimum criterion of 30 is set for anxiety ratings.